Details how to assess a child's respiratory status and the signs of the stages of respiratory failure.
PEWS - ABCDEFG
Is the airway patent/maintainable/compromised? Is there difficulty breathing/speaking? Are there associated breath sounds?
Look, Listen, Feel: Look - count RR; assess respiratory effort (i.e. use of accessory muscles, nasal flaring, abnormal rhythm, etc.); body position; colour. Listen - noisy breathing = upper airway secretions; stridor/wheeze = partial airway obstruction; grunting/gasping/apnoea. Feel - for deformities (i.e. surgical emphysema, crepitus).
Record HR, measure CRT, BP.
Asses neurological status - alert/voice/pain/unresponsive; pupil size; glucose; Glasgow Coma Scale (older children).
Temperature (consider core/peripheries); rash; pain; skin integrity (blood loss, lesions, wounds, drains); consider fluid balance
Don't Ever Forget Glucose
According to PEWS chart. RR = respiratory rate. HR = heart rate. BP= blood pressure. CRT = cap refill time.
Signs of Deterioration
Outside usual parameters for age group.
Recession/accessory muscle use
Subcostal/intercostal recession; tracheal tug.
Abnormal breath sounds
Value below 96%.
Need for inspired oxygen.
Call for help if head bobbing/grunting/gasping/apnoea/central cyanosis noted
Attempt to compensate O2 deficit & airway obstruction; beginning hypoxia
Restlessness; tachypnoea; tachycardia; diaphoresis
Imminent respiratory failure
Attempt to use accessory muscles to assist intake O2; persistent hypoxia; use up more O2 than obtained
Tachypnoea, dyspnoea & tachycardia; nasal flaring ; retractions; grunting/head bobbing; wheezing; hypoxia (<92%); difficulty speaking; anxiety/irritability; mood changes; headache; confusion
Ominous imminent respiratory arrest
Overwhelming O2 deficit; cerebral oxygenation affected (CNS changes ominous imminent respiratory arrest)
Severe hypoxia (pO2 <60%); dyspnoea/bradypnoea/silent chest/apnoea; bradycardia ; cyanosis; stupor/coma
pO2 = oxygen saturations.
Other Diagnostic Tests
Arterial blood gas
FBC - WCC slightly raised
pH 7.35-7.45; pO2 75-100mmHg (10-13.3kPa); pCO2 36-46mmHg (4.8-6.1kPa); Bicarbonate HCO3 22-30mmol/L-1; Base excess -2.3 - +2.3mmol/L
Respiratory acidosis: pCO2 and HCO3 increased, pH and pO2 decreased.
SaO2 = oxygen saturations. FBC = full blood count. WCC = white cell count. pO2 = partial pressure oxygen. pCO2 = partial pressure carbon dioxide. PEF = peak expiratory flow. FEV1 = forced expiratory volume in 1 second.
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